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Long-term Outcomes of Paediatric Patients Admitted With Acute Severe Colitis- A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN

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  • Alex Krauthammer
  • Christos Tzivinikos
  • Amit Assa
  • Erasmo Miele
  • Caterina Strisciuglio
  • Darja Urlep
  • Elena Daniela Serban
  • Avantika Singh
  • Harland S Winter
  • Richard K Russell
  • Iva Hojsak
  • Mikkel Malham
  • Víctor Manuel Navas-López
  • Nicholas M Croft
  • Huey Miin Lee
  • Oren Ledder
  • Ibrahim Shamasneh
  • Seamus Hussey
  • Hien Huynh
  • Eytan Wine
  • Neil Shah
  • Margaret Sladek
  • Tim G de Meij
  • Claudio Romano
  • Valeria Dipasquale
  • Paolo Lionetti
  • Nadeem A Afzal
  • Marina Aloi
  • Kwangyang Lee
  • Javier Martín-de-Carpi
  • Anat Yerushalmy-Feler
  • Sreedhar Subramanian
  • Batia Weiss
  • Dror S Shouval
Vis graf over relationer

BACKGROUND AND AIM: Acute severe colitis [ASC] is associated with significant morbidity in paediatric patients with ulcerative colitis [UC]. Most outcome studies in ASC since tumour necrosis factor alpha [TNFα] antagonists became available have focused on the first year after admission. The aim of this study was to characterise the longer-term outcomes of paediatric patients admitted with ASC. METHODS: This retrospective study was conducted in 25 centres across Europe and North America. Data on patients with UC aged <18 years, admitted with ASC (defined as paediatric ulcerative colitis activity index [PUCAI] score ≥65) between 2009 and 2011, were collected at discharge and 1, 3 and 5 years after admission. The primary outcome was colectomy-free rates at each time point. RESULTS: Of the 141 patients admitted with ASC, 137 [97.1%] were treated with intravenous corticosteroids. Thirty-one [22.6%] patients were escalated to second-line therapy, mainly to infliximab. Sixteen patients [11.3%] underwent colectomy before discharge. Long-term follow-up showed colectomy-free rates were 71.3%, 66.4% and 63.6% at 1, 3 and 5 years after initial ASC admission, respectively, and were similar across different age groups. Sub-analysis of colectomy rates in patients with new-onset disease [42.5% of the cohort] yielded similar results. In a multivariate analysis, use of oral steroids in the 3 months before admission, erythrocyte sedimentation rate >70 mm/h, and albumin <2.5 g/dL, were significantly associated with 5-year colectomy risk. CONCLUSIONS: High colectomy rates were demonstrated in paediatric UC patients admitted with ASC. Additional studies are required to determine whether intensification of anti-TNFα treatment, close therapeutic drug monitoring, and use of new drugs alter this outcome.

OriginalsprogEngelsk
TidsskriftJournal of Crohn's & colitis
Vol/bind13
Udgave nummer12
Sider (fra-til)1518-1526
Antal sider9
ISSN1873-9946
DOI
StatusUdgivet - 10 dec. 2019

Bibliografisk note

Copyright © 2019 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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